COLUMBIA  LIBRARIES  OFFSITE 

HEALTH  SCIENCES  STANDARD 


HX64077640 
R  A982.B65  C49        Action  of  the  truste 


RECAP 


Boston 


Actio: 


93   of  the  no^ton 


3  petit 
Lon  of  hoi  at« 


atro— 


vftmfrftf) 


CAI 


Columbia  (Brtfowsitp 

mtljeCttpofitaigork 

COLLEGE  OF 

PHYSICIANS  AND  SURGEONS 

LIBRARY 


Digitized  by  the  Internet  Archive 

in  2010  with  funding  from 

Open  Knowledge  Commons 


http://www.archive.org/details/actionoftrusteesOObost 


ACTION  OF  THE  TRUSTEES 


1 


BOSTON  CITY  HOSPITAL 


UPON  THE  PETITIONS  FOB  THE 


INTRODUCTION  OF  HOMEOPATHIC  TREATMENT, 


AND    FOR    THE 


ADMISSION    OF    MEDICAL    STUDENTS    TO    SURGICAL 
OPERATIONS    AND    CLINICAL    INSTRUCTION. 


BOSTON: 
ROCKWELL    AND     CHURCHILL,    CITY    PRINTERS, 

No.    39    ARCH     STREET. 
1886. 


Boston  City  Hospital,  Boston,  Oct.  7,  1886. 
To  Charles  G.  "Wood  and  others,  petitioners,  ashing  "  that 
homoeopathic  treatment  may  be  furnished  at  the  City  Hos- 
pital for  those  who  prefer  it  ":  — 

I  am  instructed  by  the  Trustees  of  the  City  Hospital  to 
inform  you  that  they  have  unanimously  determined  that  it  is 
inadvisable  to  grant  your  petition  that  homoeopathic  treat- 
ment be  provided  in  the  City  Hospital,  as  asked  for. 

The  Trustees  have  devoted  much  time  and  thought  to  the 
subject.  They  have  recognized  the  fact  that  the  petition  has 
been  supported  by  many  and  by  deservedly  influential  citi- 
zens of  Boston ;  and  they  have  arrived  at  their  present  con- 
clusion only  after  a  careful  hearing  and  consideration  of  the 
various  statements  and  arguments  of  the  petitioners  and  much 
further  investigation. 

The  Trustees  have  considered  that  their  first  duty  in  the 
administration  of  the  Hospital  is  the  proper  care  of  the  sick 
and  injured  who  are  put  under  their  charge.  So  far  as  is 
consistent  with  such  provision  for  the  patients,  they  are  re- 
sponsible to  the  City  Government  and  to  the  citizens  gener- 
ally for  the  economical  expenditure  of  the  large  appropriation 
which  the  necessities  of  the  Hospital  each  year  demand.  If 
the}7  cause  an  increase  in  the  running  expenses  of  the  Hos- 
pital, this  increased  expenditure  must  be  met  by  diminishing 
the  number  of  patients,  and  thereby  rejecting  deserving 
applicants  ;  or  by  lessening  the  expenses  per  patient,  thereby 
cutting  off  some  of  the  attention  or  comforts  now  deemed 
necessary ;  or  by  obtaining  from  the  City  Government  a 
larger  yearly  appropriation  from  the  tax  levy  of  the  city. 


4  Boston  City  Hospital. 

Experimental  changes  in  treatment  and  administration,  and 
the  promotion  of  scientific  knowledge,  however  desirable  in 
themselves,  must,  in  the  belief  of  the  Trustees,  be  held  sub- 
ordinate to  this  regard  for  the  welfare  of  patients  and  to 
the  economical  expenditure  of  the  money  appropriated  to 
this  end. 

The  City  Hospital  of  Boston  having,  from  its  inception 
under  the  present  sj^stem  of  management,  been  attended  with 
a  remarkable  success,  and  acquired  a  position  among  hos- 
pitals which  is  not  surpassed  in  the  country,  it  must  be 
acknowledged  that  the  present  Trustees  would  not  be  justi- 
fied in  making  a  radical  change  in  its  career,  as  called  for, 
without  satisfactory  assurance  that  the  change  would  result 
advantageously. 

The  petitioners  have  asked  for  the  introduction  of  homoeo- 
pathic treatment  for  a  portion  of  the  patients,  —  a  change  in 
the  administration  of  the  Hospital  which  must  be  accom- 
plished, if  at  all,  in  one  of  three  ways  :  — 

I.  By  introducing  another  and  independent  body  of 
physicians  and  surgeons,  side  by  side  with  the  present 
staff;  or  — 

II.  By  setting  apart  separate  existing  wards  for  a  sepa- 
rate staff ;  or  — 

III.  By  building  new  wards  for  the  homoeopathic  treat- 
ment. 


The  introduction  of  two,  and,  it  must  be  confessed,  some- 
what antagonistic  or  opposite  methods  of  treatment  into  the 
same  wards,  bringing  to  adjacent  beds  physicians  or  sur- 
geons of  different  staffs,  with  different  medicines  and 
different  diets,  whose  orders  are  to  be  executed  by  the  same 
nurses,  house  officers,  and  other  attendants,  on  different 
systems,  would   be  attended  with  so  apparent  practical  diffi- 


Homoeopathic  Treatment.  5 

culties  that  the  petitioners  themselves  were  hardly  under- 
stood to  favor  such  a  change  with  the  existing  state  of  things, 
and  this  proposition  may  be  dismissed  as  not  practicable. 

II. 

The  setting  apart  of  certain  existing  wards  for  homoeo- 
pathic treatment,  which  was  admitted  as  more  desirable,  and 
which  was  quite  generally  advocated  by  the  petitioners, 
would  undoubtedly  in  part  reduce  the  practical  difficulties, 
but  would  only  lessen  and  not  overcome  them.  The  Hos- 
pital is  a  compact  whole,  with  ward  divisions,  not  now,  in  the 
opinion  of  the  Trustees,  sufficient  in  number  to  make  so  ex- 
tensive classifications  as  are  desirable.  Patients  are  assigned 
to  the  various  wards  according  to  their  sex,  age,  and  the 
nature  of  their  complaints.  Patients,  nurses,  and  house 
officers  must  be  transferred  from  one- ward  to  another,  ac- 
cording to  the  exigencies  of  the  cases  and  the  service,  and 
the  whole  is  overlooked  by  single  supervisors  in  different 
departments,  all  subordinate  to  a  general  superintendent, 
who  is  responsible  to  the   Trustees. 

The  successful  and  economical  administration  of  an  in- 
stitution with  an  average  of  three  hundred  and  fifty  patients 
and  in  all  of  five  hundred  and  fifty  people,  almost  literally 
under  a  single  roof,  depends  largely  upon  the  harmonious 
working  of  its  different  departments.  If  different  methods 
of  practice  are  introduced  into  different  wards  there  must  be 
constant  confusion  and  trouble  arising  among  house  officers 
and  nurses  attempting  sometimes  to  follow  one  system  and 
sometimes  another.  Nurses  and  house  officers,  if  possibly 
mentally  qualified  to  pursue  their  duties  under  opposite 
methods  and  different  masters,  can  hardly  be  expected  to  be 
neutral  in  their  opinions,  and  perhaps  prejudices,  and  just 
complaints  would  inevitably  arise,  and  a  harmonious  admin- 
istration of  details  could  not  be  expected. 


6  Boston  City  Hospital. 

Could,  however,  such  clashing  of  interests  be  avoided  by 
introducing  again  into  the  Hospital  two  entirely  different  sets 
of  house  officers,  nurses,  and  other  subordinates  correspond- 
ing to  the  different  staffs,  additional  practical  difficulties 
would  then  arise.  House  officers,  being  students  who  have 
completed  courses  at  medical  schools,  come  to  the  Hospital 
gratuitously  for  the  knowledge  and  skill  to  be  obtained  from, 
the  service  in  its  various  departments ;  and  its  nurses  are  all 
pupils  of  the  Training  School,  coming  into  the  Hospital  for 
a  specified  period  to  go  out  into  the  community  trained  to 
pursue  their  calling  with  patients  of  every  class.  Both  the 
Hospital  and  its  assistants  materially  gain  by  this  method  of 
service,  which  would  be  much  interfered  with,  if  not  broken 
up,  by  confining  one  set  of  house  officers  and  nurses  to  one 
limited  class  of  wards  and  diseases,  and  the  other  set  of  house 
officers  and  nurses  to  another  distinct  class  of  wards  and  dis- 
eases. 

The  different  sets  of  house  officers,  nurses,  and  other  attend- 
ants to  be  thus  provided  would  materially  increase  the  total 
number  of  employes  ;  the  greater  number  of  employes  and  the 
different  systems  of  administration  would  require  additional 
room,  —  crowded  as  is  the  Hospital  already,  —  and  there  must 
follow  either  greater  expenditures  or  an  abridgment  of  the 
space  or  privileges  now  allotted  to  the  patients. 

The  suggested  injustice  done  patients,  in  not  allowing  them 
to  select  by  which  method  of  practice  they  shall  be  treated, 
is  certainly  not  overcome  by  arbitrarily  assigning  one  sex,  or 
age,  or  the  victim  of  one  kind  of  disease,  to  one  practice  or 
treatment,  and  the  other  sex,  or  another  age,  or  a  sufferer 
by  a  different  disease,  to  the  opposite  treatment. 

Again,  should  the  Trustees  set  specifically  apart  wards  for 
the  homoeopathic  treatment  of  such  patients  as  may  prefer  the 
system  of  homoeopathy,  it  is  difficult  to  see  how  they  could 
deny  other  patients  and  other  petitioners  when  requesting 
wards  to  be  assigned  for  other  schools  of  medicine,  embracing 


Homoeopathic  Treatment.  7 

considerable  numbers  of  the  citizens  of  Boston,  and  avoid 
multiplying  the  difficulties  above  set  forth. 

Were  the  double  sets  of  subordinates  practicable  the 
difficulty  of  treating  two  methods  of  practice  fairly  and 
impartially,  and  without  impairing  the  harmony  of  admin- 
istration, would  still  be  continued  as  long  as  a  single 
superintendence  continued.  For  a  superintendent  to  be  free 
from  the  charges  of  favoritism  in  the  dual  management 
would  seem  impossible,  where  two  parties  would  be  watch- 
ing their  respective  interests  with  emulation,  if  not  with 
jealousy. 

The  Trustees  have,  so  far  as  they  have  been  able,  con- 
sulted with  gentlemen  acquainted  with  hospital  manage- 
ment, and  the  general  advice  is  against  the  mingling  of  dis- 
tinctly  different  methods  of  practice  in  the  same  institution. 
They  have  examined  the  systems  of  hospital  administration  in 
other  cities,  notably  in  the  principal  hospitals  in  New  York 
and  Philadelphia,  they  have  addressed  inquiries  to  all  the 
principal  hospitals  of  the  country,  and  they  find  no  such  ex- 
periment successfully  tried.  Of  nearly  one  hundred  hospitals 
communicated  with  two  only  admit  more  than  one  method 
of  practice. 

The  general  management  of  the  institution  which  was  the 
one  hospital  in  this  country  cited  by  the  petitioners  as 
mingling  two  methods  of  practice  is  not  believed  to  be  so  sat- 
isfactory as  to  add  an  argument  in  favor  of  the  principle,  or 
to  commend  itself  to  the  Trustees  of  the  City  Hospital  as  an 
example.  The  Trustees  have  learned  of  but  a  single  other 
considerable  hospital  where  different  methods  of  practice 
have  been  at  all  introduced,  and  in  this  the  experiment, 
though  but  partially  tried,  seems  far  from  satisfactory. 

The  Trustees  cannot  therefore  avoid  the  conclusion  that 
the  introduction  of  homoeopathic  treatment,  by  setting  apart 
separate  existing  wards  for  a  homoeopathic  staff,  would  lead 
to  confusion  and  an  impaired  service,  and  would  entail,  unless 


8  Boston  City  Hospital. 

the  number  of  patients  at  present  admitted  were  diminished,  or 
the  present  privileges  of  patients  were  abridged,  considerable 
additional  yearly  expense,  for  which  the  City  Government 
would  be  called  upon  to  make  additional  appropriations.  In- 
deed, so  specific  and  limited  are  appropriations  made  by  the 
City  Council,  that  it  might  be  contended  that  the  Trustees 
would  not  be  justified  in  expending  the  appropriations  granted 
year  by  year  in  conducting  the  Hospital  upon  methods  radi- 
cally different  from  those  adopted  at  the  establishment  of  the 
Hospital  and  ever  since  followed. 

On  the  other  hand,  it  cannot  be  said  to  be  established  that 
the  welfare  of  the  patients  will  be  substantially  increased  by 
the  changes  required;  while  it  is  believed,  and  is  acknowl- 
edged, we  think,  by  the  petitioners,  that  the  advantages 
chiefly  sought  by  them  can  be  better  secured  otherwise ;  that 
the  secondary  advantages  resulting  from  the  promotion  of 
medical  science,  and  from  the  experience  to  be  gained  from 
the  treatment  of  patients  by  newer  methods,  can  certainly 
best  be  secured  by  separate  and  independent  buildings, 
alreadv  erected  or  to  be  built. 


III. 

The  practical  difficulties  enumerated,  with  others  which 
might  be  added,  and  which  must  arise  in  either  of  the  two 
solutions  suggested,  must,  it  is  believed,  make  it  regarded 
as  conclusive  that  the  desire  of  the  petitioners  can  be 
fairly  or  satisfactorily  gained  only  by  new  and  separate 
buildings. 

This  is  a  question  beyond  the  province  of  the  Trustees. 
The  appropriations  to  the  Hospital  are  made  for  specifically 
enumerated  objects, — for  supplies,  for  salaries  and  labor, 
for  fuel,  for  medical  supplies,  for  buildings  and  grounds ;  if 
new  buildings  are  to  be  erected,  or  extraordinary  repairs  are 
to  be  made,  special  appropriations  are  made  for  the  purpose ; 


HOMCEOPATHIC    TREATMENT.  9 

and  expenditures  must  be   made,  and  can  only  be  made,  by 
the  Trustees,  according  to  these  defined  purposes. 

ISTew  buildings  can  be  obtained  or  erected  and  proper 
provision  made  for  hoinceopathic  treatment  whenever  the 
city,  through  its  chosen  government,  shall  say  that  it  desires 
that  homceopathic  treatment  shall  be  given  to  those  of  its 
citizens  who  prefer  it. 

The  Trustees  cannot,  therefore,  but  feel  that  upon  further 
consideration  the  petitioners  will  be  satisfied  that  the  proper 
method  of  the  introduction  of  homoeopathic  hospital  treat- 
ment by  the  city  is  through  separate  buildings  under  a  distinct 
management ;  that  only  in  this  way  can  results  satisfactory  to 
themselves  be  obtained,  and  that  to  this  end  the  City  Govern- 
ment, and  not  the  Trustees  of  the  City  Hospital,  are  the 
body  proper  to  determine  how  and  when  the  city  shall  pro- 
vide treatment  specially  homceopathic  to  such  of  its  citizens 
as  shall  desire  that  treatment,  when  compelled  to  seek  assist- 
ance at  a  public  institution. 

Very  respectfully  yours, 

HENEY  H.    SPEAGUE, 

Secretary. 


10  Boston  City  Hospital. 

Boston  City  Hospital,  Boston,  Oct.   7,  1886. 

To  William  F.  Warren,  President  of  Boston  University, 
and  others,  petitioners  that  the  students  of  the  Boston 
University  School  of  Medicine  may  be  allowed  to  visit  the 
City  Hospital  for  clinical  purposes  on  the  same  terms  and 
with  the  same  privileges  as  the  students  of  the  Harvard 
Medical  School;  S.  W.  Harmon  and  others,  petitioners 
that  all  clinical  advantages  and  privileges  of  the  Hospital 
may  be  made  equally  available  to  all  students  pursuing  the 
study  of  medicine  in  Boston;  and  James  White  and  others, 
petitioners  that  the  Trustees  allow  all  medical  students  and 
physicians  to  visit  the  Hospital  for  purposes  of  medical 
study  and  observation  on  equal  terms  and  subject  to  the 
same  conditions :  — 

I  am  requested  to  comiiiiinicate  to  you  the  action  of  the 
Trustees  of  the  City  Hospital  relative  to  the  admission  of 
medical  students  to  the  Hospital  for  purposes  of  instruction. 
The  Trustees  of  the  City  Hospital  have  hitherto  recognized 
the  desirability  of  affording  to  students  of  medicine  and  sur- 
gery such  opportunities  for  observation  and  instruction  as 
might  be  properly  granted  without  detriment  to  the  main 
purposes  of  the  Hospital. 

Rale  No.  159  permits  male  medical  practitioners  and  stu- 
dents to  be  admitted  to  the  amphitheatre  of  the  Hospital  on 
operating  days,  under  such  restrictions  as  may  be  imposed  by 
the  Trustees.  Under  this  rule,  substantially  all  male  appli- 
cants, so  long  as  they  have  maintained  proper  order,  have 
been  admitted  to  the  amphitheatre  once  a  week,  to  witness 
the  operations  and  listen  to  the  clinical  instruction  given  by 
the  operating  surgeon. 

It  has  been  made  a  regulation  that  no  operation  should  be 
performed  upon  a  woman  without  the  attendance  of  a  female 
nurse,  and  that  no  operation  upon  women  should  be  made  in 
public  when  requiring  an  exposure  of  the  genital  organs. 


Admission  of  Medical  Students.  11 

Rule  No.  158  provides  that  practitioners  of  medicine  of  one 
year's  standing,  on  recommendation  of  the  Visiting  Staff,  may, 
by  vote  of  the  Trustees,  receive  cards  of  admission  to  follow 
the  practice  of  the  Hospital  for  not  more  than  one  year. 
This  is  a  rule  passed  long  since,  and,  though  continued  upon 
the  records,  no  action  under  it  has  been  taken  by  the  Trustees 
for  many  years. 

The  Trustees,  however,  have  tacitly  allowed  members  of 
the  Visiting  Staff  to  invite  such  physicians,  students,  or 
others,  as  they  might  desire,  to  visit  the  wards  of  the  Hos- 
pital with  themselves,  while  making  their  daily  rounds,  and, 
on  some  occasions,  patients  have  been  taken  from  the  wards 
into  adjoining  rooms,  and  their  cases  explained  more  at  length 
by  the  attending  physician  or  surgeon.  Members  of  the 
Out-patient  Staff  have,  also,  by  invitation,  to  a  very  limited 
extent,  introduced  students  at  their  examinations  of  patients  ; 
but  this  has  generally  been  done  for  the  purpose  of  obtaining 
some  assistance  from  the  students.  Inasmuch  as  several 
members  of  the  staff  are  also  professors  of  the  Harvard  Medi- 
cal School,  these  gentlemen  undoubtedly  have  chiefly  invited 
students  of  that  school  to  accompany  them  in  their  visits,  but, 
by  a  tacit  understanding,  one  of  their  visits  each  week  has 
been  attended  by  students  generally.  The  students,  on  such 
occasions,  have  received  valuable  clinical  instruction. 

No  invitation  or  permission  has  otherwise  been  accorded 
by  the  Trustees  to  the  students  of  the  Harvard  Medical 
School,  or  to  others,  though  some  tickets  formerly  printed 
for  giving  admission  to  the  amphitheatre  may  have  been 
improperly  or  inadvertently  used  for  such  purpose.  The 
Trustees  have  formally  recognized  the  practice,  exercised  by 
members  of  the  staff,  of  inviting  students  to  the  wards,  only  so 
far  as  to  provide  that  such  visiting  shall  never  be  carried  to 
the  detriment  of  the  patients  or  the  injury  of  the  Hospital; 
and  they  have  at  times  informally  restricted  the  privilege,  as 
by  instructing  the  superintendent  to  see  that  no  patient  ^° 


12  Boston  City  Hospital. 

made  the  subject  of  instruction  to  his  detriment  or  against  his 
wish,  and  that  students  be  not  allowed  to  visit  the  wards  in 
inconvenient  numbers. 

The  Trustees,  while  endeavoring  to  hold  the  members  of 
the  staff  to  a  paramount  duty  to  the  Hospital  of  securing, 
by  the  best  possible  care,  the  welfare  of  the  patients,  —  a 
service  which  is  invariably  performed  gratuitously  by  the 
members  of  the  staff,  —  have  assumed  that  the  instruction 
of  students  is  in  no  wise  a  further  duty  on  the  part  of  the 
members  of  the  staff  to  the  Hospital,  but  that,  in  considera- 
tion of  their  valuable  and  gratuitous  labors,  it  was  proper 
to  suffer  such  instruction  to  be  given  by  them  individually 
in  such  manner  as  they  should  desire,  provided  always  that 
no  injury  should  come  to  the  patients  or  the  Hospital. 

Several  years  ago,  however,  it  was  required,  in  accordance 
with  the  present  Eule  No.  159,  that  in  case  operations 
should  be  performed  in  the  public  amphitheatre,  and  clinical 
instruction  be  there  given,  all  male  students  should,  under 
proper  regulations,  be  admitted. 

A  due  consideration  of  the  petitions  now  before  them  has 
caused  the  Trustees  not  only  to  reexamine  carefully  the 
rules  and  practice  now  existing  in  the  City  Hospital  as  to 
medical  and  surgical  instruction,  but  also  to  investigate  and 
endeavor  to  ascertain  accurately  the  position  taken  elsewhere 
in  the  matter  of  such  instruction. 

The  Trustees  have,  by  personal  investigation  in  New  York 
and  Philadelphia,  and  by  letters  of  inquiry  to  other  cities,  as- 
certained, so  far  as  possible,  the  practice  of  the  leading  hospi- 
tals in  the  country.  Endeavor  has  been  made  to  make  the 
information  accurate,  and  the  inquiries  have  been  answered 
in  nearly  all  cases  by  the  persons  officially  authorized  to 
speak  for  their  respective  hospitals. 

The  question  of  instruction  to  students  has  been  consid- 
ered :  — 


Admission  of  Medical  Students.  13 

1st.  As  to  surgical  operations  and  clinical  instruction  in 
the  amphitheatre  or  other  public  room  ; 

2d.  As  to  instruction  in  the  wards  or  iu  the  out-patient 
rooms  ; 

3d.  As  to  the  admission  of  female  students  to  the  various 
privileges. 

As  New  York  and  Philadelphia  are  great  centres  of 
medical  education,  the  information  imparted  to  the  Trus- 
tees at  the  leading  hospitals  in  those  cities  is  given  in  con- 
siderable detail,  because  the  practices  prevailing  in  those 
cities  are  not  only  in  themselves  important,  but  are  also  rep- 
resentative and  explanatory  of  the  statistics  more  generally 
given  as  to  hospitals  throughout  the  country.  The  practice 
in  these  hospitals,  as  told  to  the  Trustees,  is  as  follows  :  — 

New  York. 

At  the  Bellevue  Hospital,  the  city  hospital  of  New  York 
for  acute  and  surgical  cases,  and  the  leading  hospital  of  that 
city,  if  not  of  the  country,  in  the  regard  of  medical  instruc- 
tion, all  students,  without  distinction  of  sex  or  school  of 
medicine,  are  admitted  free  to  the  operations  and  to  such 
instruction  as  is  given  in  the  amphitheatre.  The  hospital 
is  in  four  divisions,  and  the  members  of  the  Visiting  Staff  are 
appointed,  three  divisions  respectively  from  the  instructors 
of  the  three  leading  medical  schools,  and  one  division  from 
the  body  of  physicians  not  connected  with  either  school,  all 
the  staff,  however,  being  of  the  regular  profession.  Each 
division  is  allowed  to  give  instruction  in  the  amphitheatre, 
and  not  only  surgical  operations  are  performed  there,  and  the 
cases  lectured  upon,  but  patients  in  the  medical  wards  of  the 
hospital  are  brought  into  the  amphitheatre  and  made  the 
subject  of  medical  instruction.  The  attendance  is  very  large, 
often  from  four  hundred  to  five  hundred  students  from  various 


14  Boston  City  Hospital. 

institutions,  including  an  average  attendance  of  perhaps  six 
or  eight  female  students.  On  the  other  hand,  no  instruction 
is  recognized  in  the  wards,  and  only  as  a  matter  of  courtesy- 
are  the  various  professors  suffered,  on  their  own  invitation,  to 
permit  students  to  attend  them  in  their  hospital  visits.  This 
tacit  permission  is  made  use  of  by  a  part  only  of  the  profes- 
sors connected  with  the  hospital,  and  while  fifteen  is  the 
understood  limit  as  to  number,  seldom,  if  ever,  are  more  than 
twenty-five  students  at  a  time  in  attendance. 

The  Out-patient  department  of  Bellevue  Hospital  is  lo- 
cated in  the  basement  of  the  Bellevue  Medical  College,  a 
private  institution.  In  the  Out-patient  department  no  in- 
struction is  afforded,  except  in  a  few  instances  by  the 
attending  physician  to  a  small  number  of  private  pupils, 
seldom  exceeding  two  or  three. 

In  the  Charity  Hospital,  the  other  hospital  supported  by 
the  city,  which  is  for  chronic  cases  exclusively,  and  re- 
mote in  its  situation,  though  similar  rules  apply,  little  in- 
struction is  given,  but  patients,  whose  condition  admits  the 
removal,  are  tacitly  allowed  to  be  taken  to  the  medical  schools 
for  the  class  instruction  of  the  professors  in  charge  of  the 
various  wards. 

The  New  York  Hospital  is  the  oldest  in  New  York,  and  is 
a  private  institution  corresponding  to  the  Massachusetts  Gen- 
eral Hospital. 

A  by-law  of  the  hospital  provides  as  follows  :  — 

"In  order  to  render  the  hospital,  so  far  as  may  consist 
with  the  welfare  of  the  patients,  conducive  to  the  advance- 
ment of  medical  science,  the  physicians  and  surgeons  may 
provide  among  themselves  adequate  and  regular  practical 
instruction,  by  observations  accompanying  operations  and 
prescriptions,  by  clinical  lectures,  or  otherwise,  to  the 
students  admitted  to  see  the  practice  of  the  house.  Due 
notice  of  the  time  and  period  of  such  instruction  shall   be 


Admission  of  Medical  Students.  17 

of  recognized  colleges,  but  not  of  "  irregular  schools."  The 
number  is  limited  to  fifteen,  and  is  chiefly  of  practitioners 
and  third-year  students.  The  wards  are  not  opened  to 
students.  To  the  Out-patient  department  the  attending 
physician  or  surgeon  may  invite  two  students  at  a  time,  for 
his  assistance.     The  staff  is  all  of  the  regular  profession. 

The  above  are  the  leading  New  York  hospitals,  and  embrace 
all  which  would  seem  to  attract  medical  students  in  any  con- 
siderable numbers. 

It  is  seen  that  general  instruction,  including  surgical 
operations,  open  to  all  students,  female  as  well  as  male,  is 
given  in  the  Bellevue  and  New  York  hospitals,  and  such 
general  instruction  is  confined  to  the  amphitheatre  ;  that  in 
but  a  part  only  of  the  hospitals  is  clinical  instruction  allowed 
in  the  wards,  or  in  the  Out-patient  departments,  and  in  all 
cases  where  thus  permitted  the  individual  members  of  the 
staff  are  allowed,  as  a  matter  of  courtesy,  to  instruct,  in  very 
limited  numbers,  such  students  as  they  themselves  specially 
invite. 

Philadelphia. 

The  Philadelphia  Hospital  (formerly  called  the  Blockley) 
is  the  one  general  hospital  maintained  by  the  city  of  Phila- 
delphia, and  is  intimately  connected  with  the  almshouse,  its 
patients  being  almost  entirely  of  the  pauper  class. 

Its  staff  is  wholly  of  the  regular  profession. 

Medical  and  surgical  lectures  are  given  in  the  amphitheatre, 
by  such  members  of  the  staff  as  choose  to  instruct,  the  lectu- 
rers generally  being  professors  of  the  medical  colleges.  These 
lectures  are  open  to  all  students,  and  frequently  there  is  a 
very  large  attendance. 

No  students  are  admitted  to  the  wards  for  clinical  instruc- 
tion, but  sometimes  a  surgeon  or  a  physician  has  cases  taken 
into  rooms  adjoining  the  wards  for  the  clinical  instruction  of 
a  small  number  of  students  invited  by  him. 


18  Boston  City  Hospital. 

The  Pennsylvania  Hospital  is  a  private  hospital,  the  oldest 
in  the  country,  and  was  originally  instituted  both  for  the 
treatment  of  the  sick  and  the  dissemination  of  medical  knowl- 
edge. The  rules  specify  that  the  members  of  the  staff  "  shall, 
on  the  fourth  and  seventh  days  of  each  week,  from  ten  to 
twelve  o'clock,  deliver  clinical  lectures  to  such  students  of 
medicine  as  may  have  acquired  the  right  to  attend,"  and  that 
students  can  be  admitted  on  the  recommendation  of  the  med- 
ical and  surgical  staff.  Students  are  required  to  pay  a  small 
fee  (three  dollars  to  ten  dollars  each  year) ,  and  as  a  matter 
of  fact  no  distinction  is  made  as  to  sex  or  school  of  medicine. 
Women  were  admitted  as  above  after  a  long  controversy,  and 
only  after  the  resignation  of  several  of  the  staff.  There  is 
much  opposition  among  both  members  of  the  staff  and  gov- 
ernors to  the  admission  of  women  to  the  clinics,  and  con- 
siderable feeling  against  all  clinics.  One  hundred  and  sixty 
tickets  were  thus  issued  last  year. 

No  students  or  clinical  instruction  are  permitted  in  the 
wards  of  the  hospital.  Students  to  the  number  of  two  or 
three  at  a  time  are  sometimes  invited  by  the  attending  physi- 
cian or  surgeon  to  the  Out-patient  department. 

The  Hospital  of  the  University  of  Pennsylvania  is  a  large 
hospital,  maintained  in  connection  with  the  University  School 
pf  Medicine,  and  is  used  for  the  instruction  of  its  students. 

General  clinical  instruction  is  given  in  the  amphitheatre 
only,  and  no  women  or  homoeopathists  are  admitted ;  and  in 
fact  no  one  but  students  of  the  University  are  supposed  to 
attend.  Patients  in  the  hospital  are  freely  used  in  the  am- 
phitheatre for  both  medical  and  surgical  instruction,  and  the 
Out-patient  department  is  also  drawn  upon  for  interesting 
cases.  Students,  if  taken  to  the  wards,  are  limited  to  two 
days  in  a  week  and  to  parties  of  six. 

The  Jefferson  College  Hospital  is  closely  connected  with 
the  Jefferson  College  of  Medicine,  and  admits  students  sub- 
stantially on  the  same  terms  as  the  hospital  of  the  University. 


Admission  of  Medical  Students.  19 

At  the  Episcopal  Hospital  no  clinics  or  students  are  per- 
mitted in  the  wards  of  the  hospital,  except  that  a  student  is 
occasionally  invited  to  attend  a  member  of  the  staff  on  his 
routine  visit. 

The  Women's  Hospital  is  intimately  connected  with  the 
Women's  College,  and  admits  students  of  the  Women's  Col- 
lege to  clinics  in  its  wards,  but  only  six  at  a  time,  and  such  as 
are  specially  appointed. 

Instruction  to  students  is  given  in  the  amphitheatre,  and 
patients  are  taken  from  the  wards  for  clinical  purposes. 
Homoeopathic  female  students  are,  however,  not  admitted 
to  these  privileges. 

The  Hahnemann  Medical  College  (homoeopathic)  admits 
to  clinics  only  male  homoeopathic  students,  female  homoeo- 
pathic students  having  been  expressly  refused. 

The  situation  in  Philadelphia  seems  to  be  that  all  students, 
without  discrimination,  are  distinctly  admitted  to  instruction 
in  the  amphitheatre  at  the  Philadelphia  Hospital  only,  but  as 
a  matter  of  fact  all  students,  on  payment  of  the  fee,  are  suf- 
fered to  attend  the  instruction  in  the  amphitheatre  also  at 
the  Pennsylvania  Hospital. 

Homoeopathic  male  students  are  further  admitted  to  the 
Hahnemann  Hospital,  and  female  regular  students  are  ad- 
mitted to  the  Women's  Hospital ;  otherwise  women  and 
homoeopaths  are  substantially  debarred  from  clinical  in- 
struction at  the  Hospitals. 

There  is  no  general  admission  to  the  wards  of  any  hospital 
or  to  Out-patient  examinations  ;  in  a  part  only  of  the  hos- 
pitals are  any  ward  and  Out-patient  clinics  allowed,  and  in 
these  only  in  very  limited  numbers,  and  at  the  option  and  in- 
vitation of  individual  members  of  the  visiting  staff. 

There  are  other  smaller  hospitals  in  Philadelphia,  but  these, 
as  in  New  York,  would  attract  few  students  for  clinical  in- 
struction. 


20  Boston  City  Hospital. 

The  following  rule  has  been  adopted  by  the  Trustees  of 
the  Massachusetts  General  Hospital  :  — 

"  Physicians  and  Surgeons  of  regular  standing  may  visit 
the  Hospital  on  making  themselves  known  to  the  Visiting 
Physicians  or  Surgeons,  or  to  the  Resident  Physician  ;  but 
they  are  not  to  examine  the  patients,  or  make  any  observa- 
tions upon  their  treatment,  or  attend  operations  except 
with  the  permission  of  one  of  the  Visiting  Physicians  or 
Surgeons. 

"  Students  of  medicine  may  be  admitted  to  view  the  clini- 
cal practice  of  the  Hospital  by  the  written  permission  of 
one  of  the  Visiting  Physicians  or  Surgeons,  or  of  the  Resi- 
dent Physician ;  but  female  students,  if  admitted,  shall  be 
placed  in  classes  separate  from  male  students,  and  shall 
attend  the  clinical  practice  of  the  female  wards  exclusively." 

Since  the  adoption  of  the  rule  the  Surgical  Staff  have  voted 
that  female  students  shall  not  be  allowed  to  be  present  at  the 
operations  in  the  amphitheatre.  It  is,  however,  the  prac- 
tice to  admit  male  students  without  any  restriction  to  the 
operations  in  the  amphitheatre,  no  tickets  for  the  purpose 
being  required.  The  Visiting  Physicians  and  Surgeons  who 
are  connected  with  the  Harvard  Medical  School  are  allowed 
to  take  with  them  in  their  visits  to  the  wards  such  students 
as  they  desire  ;  and  members  of  the  Out-patient  Staff  are  also 
allowed  to  invite  medical  students  to  their  examinations ;  no 
further  limitations  have  been  imposed,  but  the  invitations  of 
the  staff  are  substantially  limited  to  the  students  of  the  Har- 
vard Medical  School,  with  which  most  of  its  members  are 
connected. 

The  question  of  instruction  at  this  hospital   seems  to   be 
left  at  the  option  of  the  staff. 

Written  inquiries,  showing  the  points  upon  which  the  in- 
formation was  sought,  were  addressed  to  all  those  hospitals  in 


Admission  of  Medical  Students.  21 

the  country,  so  far  as  their  names  could  be  ascertained, 
which  would  seem  likely  to  afford  instruction  to  students. 
The  answers  received  embrace  all  the  important  hospitals, 
except  perhaps  one  or  two  in  remoter  cities. 

The  whole  number  of  hospitals  from  which  the  statistics 
have  been  received  is  ninety-one.1  Of  these,  twenty-seven 
hospitals  located  in  the  larger  cities,  —  Albany,  N.Y.  ;  Au- 
gusta, Ga.  ;  Ann  Arbor,  Mich.  ;  Baltimore,  Md.  ;  Brooklyn, 
N.Y.  ;  Buffalo,  N.Y.  ;  Chicago,  111.  ;  Cincinnati,  O. ;  Cleve- 
land, O.  ;  Denver,  Col.  ;  Indianapolis,  Ind.  ;  Kansas  City, 
Mo.  ;  Louisville,  Ky.  ;  New  Orleans,  La.  ;  New  York, 
N.Y.  ;  Philadelphia,  Penn.  ;  Quincy,  111.  ;  San  Francisco, 
Cal. ;  St.  Louis,  Mo.  ;  St.  Joseph,  Mo.  ;  Washington,  D.C.  ; 
Worcester,  Mass.,  —  are  maintained  in  whole  or  in  part  by 
the  city  or  the  State,  and  therefore  more  especially  resemble 
in  their  conditions  the  Boston  City  Hospital.  In  the  follow- 
ing statistics  these  are  termed  public  hospitals. 

The  information  from  all  the  hospitals,  including  those  of 
New  York  and  Philadelphia,  is  summarized  as  follows  :  — 

1st.  As  to  instruction  in  the  amphitheatre  or  other  public 
room :  — 

No.   of   hospitals  which  admit  students  to  surgical  opera- 
tions :  — 

Male  students  without  restrictions       .  .  .30 

"  "         on  invitation  of  the  staff  .  .     20 

"  "         of  specified  colleges     .  .  .16 

"  "         on  payment  of  a  fee 

Female  students  only         .         .  . 

—     7fi 
No.  of  hospitals  which  do  not  admit  students  to 

surgical  operations    .  .  .  .  .  .  15 

Total  number  of  hospitals  .  .  .  .  91 

1  The  names  of  all  the  hospitals  from  which  information  has  been  received  are  given  in  the 
appendix. 


22  Boston  City  Hospital. 

No.    of  public   hospitals  which  admit  students   to  surgical 
operations  :  — 


Male  students  without  restrictions 
"  "         on  invitation  of  the  staff 

"  "         of  specified  colleges 

"  "         on  payment  of  a  fee 

Female  students  only 


12 
4 

5 
4 

1 


26 


No.  of  public  hospitals  which  do  not  admit  students 

to  surgical  operations  .....  1 

Total  number  of  public  hospitals  ...  27 

Sixty  of  the  whole  number  of  hospitals  permit  medical 
as  well  as  surgical  instruction  in  the  amphitheatre  or  other 
public  room. 

2d.  As  to  instruction  in  the  wards :  — 

No.  of  hospitals  which  admit  students  to  wards  :  — 

Male  students  without  restrictions      .         .         .7 

.  "  "         on  invitation  of  the  staff       .         .     38 

"  "         of  specified  colleges      .  .         .14 

Female  students  only         .         .         .         .         .2 

-  61 
No.   of  hospitals  which  do  not  admit  students  to 

wards       ........  30 

Total  number  of  hospitals  .  .  .  .  91 

No.  of  public  hospitals  which  admit  students  to  wards  :  — 

Male  students  without  restrictions      ...       1 
"  "         on  invitation  of  the  staff         .  .     18 

"  "         of  specified  colleges      ...       3 

—  22 


Admission  of  Medical  Students.  23 

No.  of  public  hospitals  which  do  not  admit  students 

to  wards  ........  o 

Total  number  of  public  hospitals  ...  27 

In    nine  at    least  of  the    public  hospitals  the  number  of 
students  admitted  at  a  time   is   by  rule    limited  to  a  few. 

3d.     As  to  the  admission  of  female  students  the  same  as 
male  students:  — 

No.  of  hospitals  which  admit  female    students    to 

surgical  operations    ......  46 

No.  of  hospitals  which  do  not  admit  female  students 

to  surgical  operations         .....  25 

No.  of  hospitals  which  have  no  rule  upon  the  sub- 
ject, and  to  which  no  female  students  have  applied 
for  admission    .......  5 

Total  number  of  hospitals  which  admit  students 

to  surgical  operations     .....  76 

No.  of  public  hospitals  which  admit  female  students 

to  surgical  operations         .....  18 

No.  of  public  hospitals  which  do  not  admit  female 

students  to  surgical  operations  ....  6 

No.  of  public  hospitals  which  have  no  rule  upon  the 
subject,  and  to  which  no  female  students  have  ap- 
plied for  admission   ......  2 

Total  number  of  public   hospitals    which  admit 

students  to  surgical  operations         ...  26 

No.  of  hospitals  which  admit  female  students  to  wards  :  — 

On  invitation  of  the  staff  .  .  .  .  .22 

Of  specified  colleges  .....        5 

Without  restriction  ......       6 

—     33 


24  Boston  City  Hospital. 

No.  of  hospitals  which  do  not  admit  female  students 

to  wards  ........  23 

No.  of  hospitals  which  have  no  regulation  upon  the 
subject,  and  to  which  no  female  students  have  ap- 
plied for  admission   ......  5 

Total  number  of  hospitals  which  admit  students 

to  wards        .......  61 

No.    of  public  hospitals    which   admit    female   students   to 
wards :  — 

On  invitation  of  the  staff  .  .  .  .  .12 

Of  specified  colleges  .....        1 

Without  restriction  ......       0 

—     13 
No.  of  public  hospitals  which  do  not  admit  female 

students  to  wards      ......  12 

No.  of  public  hospitals  which  have  no  regulation 

upon  the  subject,  and  to  which  no  female  students 

have  applied  for  admission  ....  1 

Total    number    of  public  hospitals  which  admit 

female  students  to  wards         ....  26 

In  all  the  public  hospitals,  except  two,  the  staff  is  com- 
posed of  regular  physicians,  and  of  these  two,  one  has  both 
regular  and  homoeopathic  members,  and  the  other  has  no 
Visiting  Staff  proper,  but  a  head  or  superintendent  (regular), 
assisted  more  or  less  by  members  of  "  all  the  schools,  regular, 
irregular,  and  defective." 

Of  all  the  hospitals  answering  the  inquiries,  five  were 
homoeopathic,  the  remainder  were  regular. 

The  present  Trustees  believe  it  their  duty  to  continue  to 
make  the  proper  care  and  treatment  of  the  sick  and  injured 
the  main  and  controlling  purpose  of  the  Hospital,  and    to 


Admission  of  Medical  Students.  25 

continue  to  permit  medical  instruction  and  observation  in  the 
Hospital  only  as  incidental,  and  only  so  far  as  such  instruction 
and  observation  can  be  afforded  without  detriment  to  the 
main  purpose.  While,  as  the  Hospital  is  a  city  institution, 
they  cannot  invite  students  of  one  school  and  debar  those  of 
another,  they  cannot  assume  to  require  of  the  Hospital  staff, 
in  addition  to  the  duty  of  a  careful  attention  to  the  patients, 
the  giving  of  gratuitous  instruction  to  medical  students. 
Were  they  to  impose  the  duty  of  free  medical  instruction 
upon  the  staff,  the  Trustees  might  properly  be  called  upon  to 
say  further  that  the  instruction  should  not  be  confined  to  one 
school  of  practice,  but  made  to  extend  to  the  different  schools 
in  vogue  in  the  city. 

Being  desirous,  however,  that  the  Hospital  should  afford 
to  the  citizens  of  Boston  generally  all  incidental  advantages 
in  the  way  of  medical  knowledge  which  it  is  in  the  power  of 
the  Hospital  to  bestow,  consistent  with  the  welfare  of  the 
patients,  the  Trustees  will  gladly  continue  to  offer  the  large 
amphitheatre  to  the  staff  not  only  for  surgical  operations  or 
instruction,  but  will  willingly  extend  these  facilities  to  the 
medical  department,  requiring  that  in  every  case  of  introduc- 
ing patients  for  instruction,  the  physician  or  surgeon  in  charge 
shall  pronounce  that  the  patient  can  undergo  such  examina- 
tion and  treatment  without  injury,  and  that  the  patient  him- 
self and  the  superintendent  shall  consent  to  the  same. 

This  instruction  in  the  amphitheatre  has  hitherto,  as  has 
been  said,  been  open  to  all  male  students  of  medicine.  The 
Trustees  are  now  asked  to  extend  the  privilege  of  the  amphi- 
theatre to  female  students.  The  propriety  of  women  prac- 
tising as  physicians  or  surgeons,  and  their  comparative  ability 
and  fitness  to  pursue  this  profession,  are  not  questions  for 
the  Trustees  to  consider  in  the  official  management  of  the 
Hospital ;  they  must  recognize  the  fact  that  women  are  be- 
coming practitioners  in  all  the  schools  of  medicine ;  that 
they  are  admitted  to  the  Massachusetts  Medical  and  other 


26  Boston  City  Hospital. 

State  societies,  and  are  recognized  as  such  practitioners  by 
the  community  at  large  ;  and  that  they  are  admitted  in  com- 
mon with  male  students  to  other  leading  hospitals  of  the 
country.  The  Trustees  therefore  feel  that  there  is  no  suffi- 
cient reason  why  women  should  not  be  admitted  to  the 
public  instruction  in  the  amphitheatre  on  the  same  terms  as 
men,  except  as  to  certain  operations  from  which  a  reasonable 
sense  or  regard  for  propriety  may  exclude  them. 

They  have  therefore  determined  that  operations  and  in- 
struction in  the  amphitheatre  shall  be  open,  upon  reasonable 
regulations,  to  all  students  of  medicine,  of  one  year's  stand- 
ing, of  duly  incorporated  colleges,  with  the  proviso  that  the 
attending  surgeon  or  physician  may  on  any  occasion  reserve 
such  cases  as  he  deems  improper  for  consideration  in  the 
presence  of  students  of  both  sexes  to  the  end  of  the  lecture, 
and  before  proceeding  with  them  require  the  withdrawal  of 
all  male  or  female  students,  as  the  case  may  be. 

Such  extension  of  the  privileges  of  the  Hospital  in  the  direc- 
tion indicated,  if  accepted  by  the  staff,  will,  in  the  opinion 
of  the  Trustees,  much  increase  its  possible  usefulness  in  the 
broader  field  of  medical  science  and  knowledge.  The  medi- 
cal instruction  which  may  thus  be  incidentally  imparted  by 
the  members  of  the  staff,  who  are  of  acknowledged  eminence 
in  their  respective  departments,  will  undoubtedly  attract 
students  from  other  institutions  than  those  to  which  they  are 
themselves  attached,  and  of  other  schools  of  practice  than 
those  to  which  they  themselves  belong,  but  it  will  at  the 
same  time  thus  help  to  make  this  city  more  a  centre  for 
medical  study  and  research,  and  help  make  the  practice  of 
its  physicians,  of  whatever  school  they  follow,  more  enlight- 
ened and  beneficent.  The  staff,  in  thus  adding  to  the  general 
benefit  conferred  by  the  Hospital  upon  the  community  at 
large,  would  certainly  not  lessen  the  fame  and  prosperity  of 
the  particular  institution  especially  receiving  the  benefit  of 
their  valuable  medical  knowledge  and  experience. 


Admission  of  Medical  Students.  27 

Clinical  instruction  in  the  wards  must,  from  due  regard  to 
the  many  patients  in  various  stages  of  disease,  be  limited,  and 
conducted,  if  at  all,  with  great  care  and  circumspection.  It 
would  be  manifestly  detrimental  to  make  it  general,  as  in  the 
amphitheatre ;  and  in  no  great  hospital  in  the  country,  even 
including  those  hospitals  where  medical  instruction  would 
seem  paramount  to  the  care  of  the  patient,  are  the  wards  so 
opened  to  all  comers.  On  the  other  hand,  to  suifer  members 
of  the  Visiting  Staff  specially  to  invite  students  or  other  phy- 
sicians to  accompany  them  in  limited  numbers  on  the  Hos- 
pital visits —  always  subject  to  careful  restrictions  —  would 
seem  a  proper  return  and  courtesy  which  the  Hospital  can 
make  to  the  staff  for  their  arduous  and  gratuitous  services. 
To  compel  them  to  make  their  daily  visits  free  lectures 
to  such  medical  students  as  might  choose  to  attend,  would, 
on  the  other  hand,  seems  to  impose  an  ungracious  and 
uncalled  burden  upon  the  physician,  and  inflict  a  positive 
injury  upon  the  patient,  and  to  be  contrary  to  the  usage  of 
every  large  hospital,  so  far  as  can  be  ascertained,  in  the 
country. 

In  accordance  with  the  foregoing  conclusions,  the  Trus- 
tees have  unanimously  adopted  the  following  rules,  in  place 
of  those  formerly  existing  upon  the  subject :  — 

Eepeal  Rules  158-159-160,  and  substitute  therefor  the 
following,  — 

No.  158.  Members  of  the  Surgical  Visiting  Staff  may,  on 
regularly  appointed  days,  perform  operations  in  the  amphithea- 
tre, and  members  of  both  the  Medical  and  Surgical  Visiting 
Staff  may  likewise  give  instruction  there  in  their  respective 
departments;  and  for  the  purposes  of  instruction  they  shall, 
subject  to  such  restrictions  as  the  Trustees  may  deem  neces- 
sary, have  the  privilege  of  introducing  patients,  provided 
that  in  every  case  the  attending  surgeon  or  physician  shall 


28  Boston  City  Hospital. 

certify  in  writing  that  the  patient  may  undergo  such  exami- 
nation and  treatment  without  detriment,  and  that  the  Super- 
intendent and  the  patient  consent  thereto.  Due  notice  of  the 
nature  of  such  operations  or  instruction  shall,  so  far  as  prac- 
ticable, be  posted  in  the  Lodge. 

No.  159.  When  the  amphitheatre  is  so  opened  for  opera- 
tions and  instruction,  physicians  having  received  a  degree  of 
doctor  of  medicine,  and  students,  of  one  year's  standing,  of 
any  duly  incorporated  college  or  school  of  medicine  or  sur- 
gery, may  be  admitted  in  such  numbers  and  on  such  regula- 
tions as  the  Trustees  may  from  time  to  time  determine. 
Whenever  the  operating  surgeon  or  the  physician  shall  deem  a 
case  improper  for  consideration,  in  the  presence  of  students  of 
both  sexes,  he  may  reserve  such  case  for  the  close  of  his 
operation  or  lecture,  and  require  the  withdrawal  of  all  male 
or  female  students,  as  the  case  may  be.  No  female  patient 
shall  be  taken  into  the  amphitheatre  without  the  attendance 
of  a  nurse  (female),  and  no  operation  upon  a  female  patient 
requiring  the  exposure  of  the  genital  organs  shall  be  per- 
formed in  the  presence  of  male  visiting  students. 

No.  160.  Physicians  and  medical  students  accompanying, 
on  his  invitation,  a  member  of  the  staff  in  his  hospital  visitor 
examinations  shall  be  limited  to  such  numbers,  not  exceeding 
twenty,  and  shall  conform  to  such  regulations  as  the  Trustees 
may  from  time  to  time  determine,  and  shall  further  observe 
all  such  requests  as  to  order  and  propriety  as  the  attending 
physician  or  surgeon,  or  the  Superintendent,  may  make. 

No.  160  A.  The  persons  mentioned  in  the  preceding  rules 
shall  be  admitted  only  at  the  regular  hours  of  operations, 
lectures,  or  visiting.  Such  persons  shall,  when  required, 
show  to  the  lodge-keeper  cards  of  admission  or  of  in- 
vitation issued  in  accordance  with  the  above  rules  ;  and  all 
cards  or  invitations  so  issued  may  at  any  time  be  revoked  or 
suspended  by  the  Trustees.  All  such  tickets  shall  be  for- 
feited if  transferred  to  or   used  by  persons  other  than  those 


Admission  or  Medical  Students.  29 

to  whom  they  are  issued.  The  Superintendent  may  compel 
the  withdrawal  of  any  person  who  violates  the  regulations  of 
the  Trustees  or  good  order,  or  refuses  to  conform  to  the  re- 
quirements of  the  physician  or  surgeon  in  attendance,  and  he 
shall  report  all  such  violations,  and  all  breaches  of  the  rules, 
to  the  Trustees. 

HENEY  H.  SPRAGUE, 

Secretary. 


APPENDIX. 


List  of  Hospitals  from  which  Information  has  been  Received. 

Albany  Hospital  and  County  Hospital,  of  Albany,  N.Y.  ;  City 
Hospital  and  Freedinen's  Hospital,  of  Augusta,  Ga.  ;  Michigan 
State  University  Hospital,  of  Ann  Arbor,  Mich.  ;  Bay  View  Hos- 
pital, City  Hospital,  Hospital  of  the  Good  Samaritan,  Maryland 
Woman's  Hospital,  Maryland  University  Hospital,  Mt.  Hope 
Retreat,  Presbyterian  Eye,  Ear,  and  Throat  Charity  Hospital,  and 
St.  Agnes  Hospital,  of  Baltimore,  Md.  ;  Brooklyn  Eye  and  Ear 
Hospital,  and  Long  Island  College  Hospital,  of  Brooklyn,  N.Y.  ; 
Buffalo  General  Hospital,  Buffalo  Hospital  of  the  Sisters  of  Char- 
ity, and  St.  Francis  Asylum,  of  Buffalo,  N.Y.  ;  Mary  Fletcher 
Hospital,  of  Burlington,  Vt.  ;  Carney  Hospital,  Children's  Hospi- 
tal, Mass.  General  Hospital,  Mass.  Homoeopathic  Hospital,  and 
New  England  Hospital  for  Women  and  Children,  of  Boston, 
Mass.  ;  Augustana  Hospital,  Bennett  Hospital,  Cook  County  Hos- 
pital, Hahnemann  Hospital,  Mercy  Hospital,  Michael  Reese  Hos- 
pital, Presbyterian  Hospital,  St.  Joseph's  Hospital,  St.  Luke's 
Free  Hospital,  Women's  Hospital,  and  United  States  Marine 
Hospital,  of  Chicago,  111.  ;  Cincinnati  Hospital,  Hospital  of  the 
Protestant  Episcopal  Church,  Good  Samaritan  Hospital,  Jewish 
Hospital,  Ohio  Hospital  for  Women  and  Children,  St.  Mary's 
Hospital,  and  St.  Joseph's  Private  Lying-in  Hospital,  of  Cin- 
cinnati, O.  ;  Charity  Hospital  and  Cleveland  City  Hospital,  of 
Cleveland,  O.  ;  Arapahoe  County  Hospital,  of  Denver,  Col.  ; 
St.  Mary's  Hospital,  of  Detroit,  Mich.  ;  Hartford  Hospital, 
of  Hartford,  Conn.  ;  City  Hospital,  of  Indianapolis,  Ind.  ; 
Mercy  Hospital,  of  Iowa  City,  la.  ;  City  Hospital  and  Sisters' 
Hospital,  of  Kansas  City,  Mo.  ;  Chy  Hospital,  of  Louisville,  Ky.  ; 
Minnesota  College  Hospital,  of  Minneapolis,  Minn.  ;  New  Haven 
Hospital,  of  New   Haven,  Conn.  ;  Charity  Hospital,  of  New  Or- 


32  Boston  City  Hospital. 

leans,  La.  ;  Bellevue  Hospital,  Charity  Hospital,  Manhattan  Eye 
and  Ear  Hospital,  Mt.  Sinai  Hospital,  New  York  Hospital,  Pres- 
byterian Hospital,  Roosevelt  Hospital,  St.  Luke's  Hospital,  and 
Woman's  Hospital,  of  New  York,  N.Y.  ;  Episcopal  Hospital,  Hos- 
pital of  the  University  of  Pennsylvania,  Pennsylvania  Hospital, 
Philadelphia  Hospital,  Philadelphia  Hospital  for  Skin  Diseases, 
Wills'  Hospital,  Women's  Hospital  and  Women's  Homoeopathic 
Hospital,  of  Philadelphia,  Pa.  ;  Blessing  Hospital  and  St.  Mary's 
Hospital,  of  Quincy,  111. ;  City  and  County  Hospital,  German 
Hospital,  St.  Luke's  Hospital,  and  St.  Mary's  Hospital,  of  San 
Francisco,  Cal. ;  House  of  the  Good  Shepherd,  of  Syracuse, 
N.Y. ;  Alexian  Brothers  Hospital,  City  Hospital,  St.  John's  Hos- 
pital, and  St.  Louis  Hospital,  of  St.  Louis,  Mo.  ;  City  Hospital, 
of  St.  Joseph,  Mo.  ;  St.  Vincent  Hospital,  of  Toledo,  O.  ;  Colum- 
bia Hospital  for  Women  and  Lying-in  Asylum,  Eye  and  Ear 
Infirmary,  Freedman's  Hospital,  Garfield  Memorial  Hospital, 
National  Homoeopathic  Hospital,  and  Providence  Hospital,  of 
Washington,  D.C. ;    City  Hospital,  of   Worcester,  Mass. 


Admission  of  Medical  Students.  15 

given,  and,  when  announced,  shall  be  punctually  observed." 
(Chap.  X.,  10.) 

A  limited  list  is  kept  of  physicians  and  surgeons  and  of 
students,  about  seventy  or  eighty  in  number,  all  belonging 
to  the  regular  profession,  to  whom  the  invitations  to  the 
instruction  in  the  amphitheatre  are  regularly  sent  by  postal 
cards  containing  lists  of  the  operations.  Practically,  how- 
ever, no  tickets  being  required  for  admission,  all  students 
appearing  are  suffered  to  attend.  Few  homoeopathic  stu- 
dents attend,  and  the  question  of  their  admission  has  not  been 
formally  raised ;  but  it  was  said  that  they  would  not  be 
admitted  if  the  point  of  their  homoeopathy  were  mooted. 
Woman  students  do  attend  in  small  numbers,  frequently 
from  one  to  six  out  of  an  attendance  of  two  hundred,  but  it 
is  understood  that  they  present  themselves  before  such 
attending  surgeons  as  do  not  object  to  their  presence,  and  do 
not  attend  when  the  attending  surgeon  does  object  to  their 
admission,  the  staff  of  the  hospital  being  divided  in  their 
opinion  upon  the  subject. 

Instruction  in  the  amphitheatre  is  almost  entirely  confined 
to  the  surgeons,  one  physician  only  giving  such  instruction, 
and  that  irregularly  and  to  a  small  number  of  the  students 
of  the  college  with  which  he  is  connected  as  a  professor. 

No  students  at  all  are  allowed  in  the  wards  or  in  the  Out- 
patient department,  and  medical  instruction  is  accordingly 
confined  to  the  amphitheatre. 

The  Presbyterian  Hospital  is  a  large  hospital,  supported 
principally  by  the  Presbyterian  churches. 

In  general  no  students  are  admitted  to  the  wards,  but  if 
a  member  of  the  Visiting  Staff  should  desire  to  take  two  or 
three  students  on  his  visit  he  would  be  expected  to  obtain 
special  permission  from  the  superintendent. 

A  very  limited  number  of  students  is  sometimes  invited 
by  the  attending  surgeon  to  the  operating  room,  but  no  gen- 


16  Boston  City  Hospital. 

eral  instruction  is  afforded,  even  by  members  of  the  staff  who 
are  instructors  in  the  medical  colleges  to  their  own  stu- 
dents. It  was  said  that  no  homoeopathic  students  would  be 
admitted  to  this  hospital.  Several  years  since  women  were 
admitted  to  operations  by  one  surgeon ;  but  the  practice 
quickly  stopped  from  disfavor. 

The  St.  Luke's  Hospital  permits  no  instruction  to  stu- 
dents either  in  the  wards  or  at  the  operations,  the  govern- 
ment of  the  hospital  being  opposed  to  clinics  and  affording 
no  opportunity  for  them.  A  few  physicians,  and,  perhaps, 
occasional  students,  may  be  invited  to  special  operations.  On 
one  occasion  only  has  a  female  physician  been  invited  by  an 
attending  surgeon  to  an  operation,  and  the  affair  created 
much  opposition  from  other  members  of  the  staff  and  from 
the  government. 

At  the  Roosevelt  Hospital  no  general  clinical  instruction  is 
given.  Occasionally  students  are  specially  invited  into  the 
wards  by  the  attending  physician,  but  the  practice  is  rare. 
Invitations  are  extended  upon  operating  days  to  a  small  list 
of  persons,  principally  physicians,  made  up  by  the  staff  and 
the  superintendent.  One  of  the  Out-patient  Staff,  a  relative 
of  the  founder,  did  institute  a  private  course  of  clinics,  using 
patients  from  the  hospital,  and  to  those  female  medical  stu- 
dents were  admitted.  The  action  of  the  physician  met  with 
disfavor  from  other  members  of  the  staff,  and  from  members 
of  the  governing  board,  and  his  course  has  not  been  repeated. 

At  the  Mt.  Sinai  Hospital,  maintained  by  the  Hebrews, 
but  admitting  patients  of  all  sects  and  nationalities,  no  in- 
struction is  given  either  in  the  operating  room  or  in  the 
wards,  and  a  request  for  the  admission  of  students  was  re- 
fused by  the  managers.  Possibly  a  member  of  the  staff  may 
invite  to  his  visit  a  student,  male  or  female,  but  the  action  is 
not  supposed  to  be  known  by  the  authorities. 

The  Woman's  Hospital  admits  to  the  operations  in  the 
amphitheatre  physicians  and  surgeons,  both  male  and  female, 


COLUMBIA  UNIVERSITY  LIBRARIES 

This  book  is  due  on  the  date  indicated  below,  or  at  the 
expiration  of  a  definite  period  after  the  date  of  borrowing, 
as  provided  by  the  rules  of  the  Library  or  by  special  ar- 
rangement with  the  Librarian  in  charge. 

DATE  BORROWED 

DATE  DUE 

DATE  BORROWED 

DATE  DUE 

C28M  1  40)  m  too 

RA982.E65  C49 

Boston.  City  hospital. 


